Most of the patients had a relatively low stage of disease, when they were first seen by their Urologists. Chief Urological complaints were of Irritation in 63.6% of Parkinson's Disease and 64.3% of SpinoCerebellar Degeneration cases, compared with Obstruction in 80.0% of Multiple Sclerosis cases.

Cystometry revealed underactive Detrusor function in 69.2% of the patients with SpinoCerebellar Degeneration but no abnormalities in the patients with Parkinson's Disease or Multiple Sclerosis.

Of 34 patients, excluding one patient lost to follow-up, the period of Urological management ranged from one to 44 weeks with a mean of 11.0.

The final methods of Urinary drainage in 34 patients consisted of voluntary voiding in 20, clean Intermittent Catheterization in 11 including eight by Self-Catheterization, Incontinence into diaper in two, and Indwelling Catheter in one.

Five patients were compelled to change Urinary drainage method from voluntary voiding to clean Intermittent Catheterization because of increasing residual volume in four and progressing Bladder Deformity in one. However, none of them showed the clinical signs of primary disease progression.

These findings indicate that in patients with Parkinson's Disease, Multiple Sclerosis, and SpinoCerebellar Degeneration, the Urological symptoms can appear even in the early stage of disease.

In addition, close follow-up is important in the Urological management of Neurogenic Bladder patients with these diseases, because the disorders of the lower Urinary Tract may progress regardless of the status of the primary disease.

#2

Urinary Incontinence In Multiple Sclerosis

We report a patient with Multiple Sclerosis who manifested Urinary Incontinence as a part of Paroxysmal attacks which were characterized by sudden onset, short duration, and frequent repetition. This phenomenon has not been described previously.

Neurological examination and Magnetic Resonance Imaging suggested that Paroxysmal Urinary Incontinence was induced by an ectopic excitation of the DeMyelinating lesion in the right Rostral Pons.

The location of which was similar to the Pontine Micturition Center reported in previous animal experiments. Treatment with Tegretol (Carbamazepine), an AntiEpileptic drug, suppressed the attacks including the associated Urinary Incontinence.

#3

Single-Institution Experience In 110 Patients With Botulinum Toxin A Injection Into Bladder Or Urethra

Under light sedation in most cases, patients were treated with either 100 to 200 U of BTX-A in 4 mL divided in equal doses into the four quadrants of the External Sphincter or by injection into the Bladder base using 100 to 300 U of BTX-A diluted in approximately 10 to 30 mL of sterile saline.

At last follow-up, 27 patients had received additional injections (up to six) at intervals of 6 months or longer.

Results
Compared with reports from Western countries the ratio of emptying-to-filling symptoms was high in Japan. Of Urinary symptoms only filling correlated with disability status and disease duration.

Urinary symptoms were not related to lesion sites. Urodynamic evaluation revealed Detrusor Hyperreflexia in 14 of 32 patients, HypoReflexia or Areflexia in 12, Detrusor HyperReflexia with impaired contractile function in 4, a low compliance Bladder in 1 and normal function in 1.

Of 14 patients with HyperReflexia 13 had overactive Sphincter concurrently. Incompetent Sphincter was identified in 2 patients who had Detrusor HyperReflexia with impaired contractility and in 1 with a low compliance Bladder.

A significant correlation was noted for a Pontine lesion and Detrusor HypoReflexia, and for a Cervical Cord lesion and Detrusor-Sphincter DysSynergia.

Residual urine varied widely from 50 to 900 ml. Decreased compliance with areflexia was seen in 5 patients (5.5%) and nonrelaxing sphincter (but not contracting) with Bladder HyperContractility was noted in 9 (10%).

Statistical analysis followed comparison of 2 proportions.

When patients with a less severe form (grades 1 and 2) were differentiated from those with a more severe form of MS (grade 3), we observed a significant difference only in incontinence, high post-void residual, leg spasticity, urinary stones, hydronephrosis, type 3 Detrusor External Sphincter DysSynergia, no electromyography activity and positive sharp waves.

The variables with the highest predictive value between the groups were urinary stones, sepsis, type 3 Detrusor External Sphincter DysSynergia and no electromyography activity of the External Urethral Sphincter (100%).

Conclusions
Proper identification of the bladder and External Urethral Sphincter status, especially exclusion of Detrusor overactivity or a DysSynergic response of the External Urethral sphincter, will prevent complications that may result in deterioration of quality of life.